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INTRODUCTION

Atrial fibrillation (AF) is the most common sustained heart rhythm disorder encountered in clinical practice and is a global public health burden. Originating predominately from the left atrium, AF results in chaotic atrial activity manifesting clinically as an irregular cardiac rate and cardiac output Chugh, Havmoeller, & Narayanan, (2014).

Atrial fibrillation is not benign and results in a hypercoagulable state predisposing to an increased risk of stroke. A substantial proportion of patients with AF have no symptoms and are referred to as having asymptomatic or silent AF Lip, Fauchier, Freedman, Van, Natale, et al., (2016;…). Therefore, early detection and subsequent provision stroke preventative treatment in patients with silent AF may have significant public health benefits Freedman, Camm, Calkins, Healey, Rosenqvist, et al., (2017 ;…).

Despite good progress in the management of patients with AF, this arrhythmia remains one of the major causes of stroke, heart failure, sudden and death in the world. Furthermore, the number of patients with AF is predicted to rise steeply in the coming years Kirchhof, Benussi, Kotecha, Ahlsson, Atar, et al., (2016;…).

To meet the growing demand for effective care of patients with AF, new information is continually generated and published. Re?ecting the multidisciplinary input into the management of patients with AF, the Task Force includes cardiologists and specialist nurses amongst itsmembers (Hendrikx, Rosenqvist, Sandstrom, Persson, Hornsten, et al., (2016;…).
Therefore, there is an urgent need for a new approach to care delivery in AF to enhance outcomes in this burgeoning population. Non-modifiable risk factors exist for the development of AF including rheumatic heart disease, ageing, and genetics, recently there has been a greater awareness on the role of modifiable cardiovascular risk factors (Gupta, Perera, &Ganesan, 2013).

Current evidence suggests that patients with effective self-care skills make better use of health professionals’ time, have enhanced self-care skills and improved quality of life. The person often has more knowledge of their condition than the health professional, and their care may be coordinated in a team-based arrangement (Lawn ; Schoo, 2010).

Quality of life for people with chronic conditions is dependent on the
person’s ability to self-manage their condition, and although compliance to health advice is expected, results can be variable. Older people may present with comorbidities even in the acute setting, and an understanding of chronic care and self-management support and techniques will aid health professionals to assist them to keep healthy (Gallagher, Donoghue, Chenoweth, & Stein-Parbury, 2008).

Self-care involves the individual with a chronic condition working in partnership with their cares and health professionals so that they can negotiate a plan of care and review or monitor the plan (Lake & Staiger 2010).Self-management interventions and support aim to develop a person’s self-efficacy and the health professional assists the person to engage in activities that protect and promote health, and aid the person to monitor and manage the symptoms and signs of their condition (Coleman, Austin, Brach, ; Wagner, 2009).
Significance of the Study:
In 2010, the estimated numbers of men and women with AF worldwide were 20.9 million and 12.6 million, More than 750,000 hospitalizations occur each year because of AF. The condition contributes to an estimated 130,000 deaths each year (Agency for Healthcare Research and Quality, 2012).

Estimates suggest an AF prevalence of approximately 3% in adults aged 20 years or older with greater prevalence in older persons and in patients with conditions such as hypertension, heart failure, coronary artery disease (CAD), valvular heart disease, obesity, or diabetes mellitus (Haim, Hoshen, Reges, Rabi, Balicer, et al., (2015;…).

Atrial fibrillation AF is independently associated with a two-fold increased risk of all-cause mortality in women and a 1.5-fold increase in men. Death due to stroke can largely be mitigated by anticoagulation, while other cardiovascular deaths, for example due to heart failure and sudden death, remain common even in AF patients treated according to the current evidence base. AF is also associated with increased morbidity, such as heart failure and stroke (Kotecha, Holmes, Krum, Altman, Manzano, et al., (2014;…).

World health organization (WHO) estimated that the number of Individuals with AF in 2015 at Egypt was extrapolate 559,686 population estimated for 76,117,421(World health organization, 2015). In addition, number of patients admitted to El-zohor, Port Said general and El-tadamon hospitals during the period of 2014 -2015 due to AF disease were 215 Patients according to (annual statistic of Port Said hospitals, 2015).

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